So, bottom line... what is the future of anesthesiology for MDs?

[bala1]

CA-1 here. For the love of god stop obsessing about money all the time. Anesthesia is great, even if I end up making 150k per year with a couple weeks vacation. Blade needs to relax

Anesthesiologists are way way way overpaid as it is. Especially those who supervise, whether its residents or CRNAs or AAs. I've seen all these attendings say how hard it is as how they all deserve more pay. But please, give me a break. Anesthesia, while
Complex, is very master able in 3 years of residency. So sack up and work hard and be happy making what you make. As residents we make very little and do most of the actual work

..
How do you argue with the above.... LOL

I give him 3 weeks after you graduate in a busy trauma center. or any place that does high index cases supervising four rooms with nurses who are ok but not great. . for 150K or I will even up that to 200k.. and ill give you four weeks vacation.. I bet you any amount of money you will consider ending your life...

---

Members don't see this ad.

 

[bala1]

where is this from blade?

 

[bala1]

Slim,

How much was your education and sacrifice worth? What is the fair market value for your services? You are welcome to give all your money away when and if you earn it. But, please leave the rest of us out of your personal decisions.

As for this field not being "hard" you are either foolish, ignorant or both. Every day I go to work hoping and trying to avoid any complications which could have dire consequences for my patients. The more patients/anesthetics I do the more I worry something will go wrong.

Never a more accurate post has ever been posted on SDN, Blade. You can go into work and everything is fine and you can walk out without a careoer. This job is stressful and HARD. And it accumulates.

 

[doctor712]

Real life example of medical school debt

Kevin | Education | April 4, 2011


by Pierce Hibma

Want to really understand the reality of US medical education debt? Then allow me to pull back the curtains to expose the financial monster that awaits me after I earn my MD.



I am a third medical student at a private medical school in the Midwest. Fortunately, I was able to graduate from college without any financial debt thanks to an athletic scholarship. Unfortunately, I, like many other medical students, pay for my entire medical education and living expenses through student loans.

The average medical school debt today, according to the Association of American Medical Colleges is $156,456. I can only wish that was true for me. Perhaps the best way to understand the burden of a current medical student's debt is by example. Here is an approximation of my real-life medical school debt assuming I select forbearance during residency and repay the loan over 15 years:

Annual cost of tuition: $48,000
Annual cost of attendance: $67,500 (Includes costs of books/supplies, loan fees, health insurance, licensure fees, living expenses, and transportation allowance)

Total balance after medical school: $270,000
Amount subsidized: $34,000
Amount unsubsidized: $236,000

Interest incurred during 3 years of residency: $100,000
Total balance after residency: $370,000

Monthly payment after residency: $3,370 (180 total payments)
Interest incurred after residency: $237,000
Total repayment: $607,000

These financial conclusions were reached via the Association of American Medical Colleges' Medloans Calculator. Again, these numbers are approximations and many different repayment plans exist, but it certainly highlights the massive financial burdens placed on today's medical students

Lemme add one modern day reality to this pearl of a post: there are no more subsidized loans for med school. It's ALL unsubsidized down. Nice, right?

D712

 

[polar403]

Lemme add one modern day reality to this pearl of a post: there are no more subsidized loans for med school. It's ALL unsubsidized down. Nice, right?

D712

And locked in at a fixed 6.8% interest rate. Can't consolidate those loans to get a lower rate anymore.

Government is making bank off of our loan interest and will be reimbursing us less for our services in the future. We are really getting screwed.

 

[jwk]

I am zero percent worried about CRNAs...he are producing a far weaker product than our residency programs

I would say anesthesiologists should make around 150-200k per year and CRNAs around 70-80k

Both of you are absolute fools if you believe what you're posting.

 

[Stank811]

Both of you are absolute fools if you believe what you're posting.

Fine maybe 1%....but I stand by my statement, I am not worried about CRNAs taking over. Why you are so worried for anesthesiologist JWK? What are you seeing that I am missing? You have been doing this for decades longer than I have....haven't you seen the same arguments occurring your whole career?

 

[jwk]

Fine maybe 1%....but I stand by my statement, I am not worried about CRNAs taking over. Why you are so worried for anesthesiologist JWK? What are you seeing that I am missing? You have been doing this for decades longer than I have....haven't you seen the same arguments occurring your whole career?

The CRNA's are FAR more militant and politically active than they were even five years ago. They stop at nothing. Facts are irrelavent to them. It was bad enough when they simply had a certificate and no degree, but now they're getting doctorates (with absolutely zero additional clinical training) and claiming equivalency. Their political machine is unfortunately impressive, and well versed in meaningless and untrue but effective propaganda - kinda like the healthcare equivalent of Democrats. It doesn't matter if it's true or not - you just repeat it often enough that it starts to be believed.

 

[BLADEMDA]

The CRNA's are FAR more militant and politically active than they were even five years ago. They stop at nothing. Facts are irrelavent to them. It was bad enough when they simply had a certificate and no degree, but now they're getting doctorates (with absolutely zero additional clinical training) and claiming equivalency. Their political machine is unfortunately impressive, and well versed in meaningless and untrue but effective propaganda - kinda like the healthcare equivalent of Democrats. It doesn't matter if it's true or not - you just repeat it often enough that it starts to be believed.

Absolutely correct JWK. The irony is that the clinical training is actually worse than 5 years ago as schools open programs across the nation and existing programs add more spots. So, while the AANA clauims "Doctorate level Training" the actual clinical time is both less intense and limited in content compared to just 5 years ago.

New CRNA graduates are, as a whole, inadequatly trained for even a "collaborative" practice. These new graduates need years of experience to gain the training their COA/AANA denied them during school due to restrictions of work hours, limited clinical exposure and watered down graduation requirements. The AANA propaganda of graduating an Independent Provider has never, and I mean never, been farther from the truth. I truly believe more than a few patients will die unnecessarily at the hands of these so called "equivalent" providers once ObamaCare turns them loose solo on society.

 

[Stank811]

Absolutely correct JWK. The irony is that the clinical training is actually worse than 5 years ago as schools open programs across the nation and existing programs add more spots. So, while the AANA clauims "Doctorate level Training" the actual clinical time is both less intense and limited in content compared to just 5 years ago.

New CRNA graduates are, as a whole, inadequatly trained for even a "collaborative" practice. These new graduates need years of experience to gain the training their COA/AANA denied them during school due to restrictions of work hours, limited clinical exposure and watered down graduation requirements. The AANA propaganda of graduating an Independent Provider has never, and I mean never, been farther from the truth. I truly believe more than a few patients will die unnecessarily at the hands of these so called "equivalent" providers once ObamaCare turns them loose solo on society.

Agree and this is why I am not to concerned. The have created an environment that they are considered equivalent at a legislative level but the argument can not be taken further. And with all the malignant political actions they continue to make it turns all physicians and other midlevels against them (CRNAs/NPs) creating a system in which physicians do not want to teach them more than the min. and also do not want to hire them. Two months ago I worked with a SRNA who will be graduating in May and the "biggest case" they did was a VP shunt revision on an adult, no major vascular, no intra-thoracic, no cardiac, no cranis, no regional outside a handful of spinals and epidurals....they were on their heart month and literally watched me do hearts and could not have learned much based on their level of involvement. They performed a couple art lines and no CVLs. They struggled with large bore IVs. The fact that they never did a CVL wasn't really a concern since they did several on a simulator and "likely wont be placing them in practice". The new breed of SRNA are largely after the lifestyle and $$$ but also have no problem claiming equivalence because this is their path to the $$$. Honestly, I felt a little sad for how poor their education actually was and scared for them in the future.

 

[Arch Guillotti]

A major problem is when these idiots go to work for a practice with lax supervision or some idiotic type 'collaborative" practice. Poorly trained now-CRNA's are turned loose to wreak their havoc.

Agree and this is why I am not to concerned. The have created an environment that they are considered equivalent at a legislative level but the argument can not be taken further. And with all the malignant political actions they continue to make it turns all physicians and other midlevels against them (CRNAs/NPs) creating a system in which physicians do not want to teach them more than the min. and also do not want to hire them. Two months ago I worked with a SRNA who will be graduating in May and the "biggest case" they did was a VP shunt revision on an adult, no major vascular, no intra-thoracic, no cardiac, no cranis, no regional outside a handful of spinals and epidurals....they were on their heart month and literally watched me do hearts and could not have learned much based on their level of involvement. They performed a couple art lines and no CVLs. They struggled with large bore IVs. The fact that they never did a CVL wasn't really a concern since they did several on a simulator and "likely wont be placing them in practice". The new breed of SRNA are largely after the lifestyle and $$$ but also have no problem claiming equivalence because this is their path to the $$$. Honestly, I felt a little sad for how poor their education actually was and scared for them in the future.

 

[usermike8500]

This article basically claims CRNAs are equivalent to Physicians:

http://www.aana.com/advocacy/federa...ts Work Without Supervision By Physicians.pdf


This article claims that CRNAs are more cost-effective than Physicians:

http://www.aana.com/advocacy/federalgovernmentaffairs/Documents/Value of CRNA Care Study.pdf


Are there any studies done to counter these? I haven't been able to find any studies which provide evidence that Physicians are in fact superior to their CRNA counterparts. Obviously it seems like the anesthesiologist's 13 years of training should render him/her superior to the CRNA with only 4 years (+ 1 yr ICU experience). I just haven't found any evidence that proves this to be true.

 

[cincincyreds]

This article basically claims CRNAs are equivalent to Physicians:

http://www.aana.com/advocacy/federa...ts Work Without Supervision By Physicians.pdf


This article claims that CRNAs are more cost-effective than Physicians:

http://www.aana.com/advocacy/federalgovernmentaffairs/Documents/Value of CRNA Care Study.pdf


Are there any studies done to counter these? I haven't been able to find any studies which provide evidence that Physicians are in fact superior to their CRNA counterparts. Obviously it seems like the anesthesiologist's 13 years of training should render him/her superior to the CRNA with only 4 years (+ 1 yr ICU experience). I just haven't found any evidence that proves this to be true.

It is also cheaper to field the Pittsburgh Pirates versus the New York Yankees. They do consider the Pittsburgh Pirates a major leage baseball club.

I had a patient last week who was extremely worried because they saw a video that said "a nurse" was going to be taking care of them when under anesthesia. When I told the patient we don't have "nurses do anesthesia"' in our hospital, they were so relieved to hear that from me.

 

[scudrunner]

This article basically claims CRNAs are equivalent to Physicians:

http://www.aana.com/advocacy/federa...ts Work Without Supervision By Physicians.pdf


This article claims that CRNAs are more cost-effective than Physicians:

http://www.aana.com/advocacy/federalgovernmentaffairs/Documents/Value of CRNA Care Study.pdf


Are there any studies done to counter these? I haven't been able to find any studies which provide evidence that Physicians are in fact superior to their CRNA counterparts. Obviously it seems like the anesthesiologist's 13 years of training should render him/her superior to the CRNA with only 4 years (+ 1 yr ICU experience). I just haven't found any evidence that proves this to be true.

I wish people would start acknowledging the number of hours worked when comparing physicians compensation to that of the nurse anesthetist. If they just calculated an hourly rate, it would show the real compensation. Then, let the administrators and pubic decide who they want managing their anesthetic if the hourly rate is comparable.

Also, when these idiots start talking about saving the hospital money by using nurses, they are simply allowing the hospital to skim off the top of the anesthesia billing. This isn't saving the hospital money, it's paying the hospital to employ you, which is illegal if you are a contracted private practice. So, the hospitals could employ the nurses, but they would have to employ more nurses to meet the production of 1 physician because they are certainly not going to work more than their 36 hours/wk, vs. the 60+ of a physician. If that's the case, there goes the savings.

So, the whole cost effectiveness argument is garbage. I think the ASA needs to shine light on these holes for the public/politicians/hospital administrators to see.

 

[ProwlerturnGas]

The ASA??? You've got to be kidding me.....Politically correct machine. Dont expect any salvation from them.

 

[BLADEMDA]

I wish people would start acknowledging the number of hours worked when comparing physicians compensation to that of the nurse anesthetist. If they just calculated an hourly rate, it would show the real compensation. Then, let the administrators and pubic decide who they want managing their anesthetic if the hourly rate is comparable.

Also, when these idiots start talking about saving the hospital money by using nurses, they are simply allowing the hospital to skim off the top of the anesthesia billing. This isn't saving the hospital money, it's paying the hospital to employ you, which is illegal if you are a contracted private practice. So, the hospitals could employ the nurses, but they would have to employ more nurses to meet the production of 1 physician because they are certainly not going to work more than their 36 hours/wk, vs. the 60+ of a physician. If that's the case, there goes the savings.

So, the whole cost effectiveness argument is garbage. I think the ASA needs to shine light on these holes for the public/politicians/hospital administrators to see.

The future is ACOs, AMCs or Hospital Based employment. This means the overall cost will be part of the budgest process. In many hospital settings there is no "skimming off the top" because the anesthesia department requires a subsidy; hence, by utilizing more midlevel providers at a ratio of 5:1 (midlevels to MDs) the hospital can cut or eliminate the subsidy.

The problem with AAs are the laws restrict AA practice to 4:1 medical direction when in fact, the trend is medical supervision in order to save money. Hopefully, ObamaCare will include the AAs in any revisions to CMS guidlines for anesthesia supervision.

I see CRNA salaries falling to $100-$110K for 40 hours per week with "on call" requirements for additional staffing. I see Anesthesiologist income Falling to around $250 (easy low acuity hospital) to $350 (high acuity, Trauma hospital) for 50 hours per week.
For those who are unaware salary ranges for both groups are considerably higher in 2012 than I believe they will be in 2018.

I truly hope I am wrong about income for this field; but, the country is broke and more patients are going to show up on Medicaid/Medicare than ever before COMBINED with the fact that hospitals are reducing subsidies across the nation.

Socialized medicine may be viewed as a good thing by some on this board; but, the end result will be curtailed access to expensive surgeries/procedures and reduced incomes for Physicians especially Anesthesiologists and Radiologists.

 

[scudrunner]

The ASA??? You've got to be kidding me.....Politically correct machine. Dont expect any salvation from them.

You are not confusing the AMA with the ASA, are you?

 

[ProwlerturnGas]

AMA is worse!

 

[BLADEMDA]

This article basically claims CRNAs are equivalent to Physicians:

http://www.aana.com/advocacy/federa...ts Work Without Supervision By Physicians.pdf


This article claims that CRNAs are more cost-effective than Physicians:

http://www.aana.com/advocacy/federalgovernmentaffairs/Documents/Value of CRNA Care Study.pdf


Are there any studies done to counter these? I haven't been able to find any studies which provide evidence that Physicians are in fact superior to their CRNA counterparts. Obviously it seems like the anesthesiologist's 13 years of training should render him/her superior to the CRNA with only 4 years (+ 1 yr ICU experience). I just haven't found any evidence that proves this to be true.

The most cost effective model is a salaried CRNA only model where the hospital employs the CRNA at $130K per year for 50 hours per week (call included).

The SAFEST and most cost effective model is the ACT where the hospital employs all anesthesia providers and puts them on call.

Despite the AANA Propaganda most CRNAs know their limitations and underestand that a significant percentage of CRNAs lack the skill and knowledge to practice Independently. Hospital CEOs won't allow Independent CRNA practice in a high acuity setting because patients will die as a result of that decision.

But, a CRNA with 5 years experience who is in the upper 1/3 Tier can, most likely, do safe anesthesia SOLO in an low acuity setting. I don't think that should be permitted but I'm not going to argue that JWK or any similarly experienced midlevel provider couldn't do a safe anesthetic in such a setting.

 

[scudrunner]

AMA is worse!

Indeed. Didn't think the ASA was particularly apathetic toward this issue.

 

[KCBarbarossa]

Medicine is changing. It is what it is. We should fight the battle with less emotion for our own sanity. The alternative is to go crazy fretting about the future.

My own personal ideology is that we can NEVER lose our OR skills. If there comes a day when ACT ratios increase beyond 4:1 I simply wouldn't want any part of that. I'd like to think I'd be prepared to take a major pay cut and stool sit my own cases if it came to that.

To do that, however, requires us to be dialed in to the flow of the OR. Knowing how to calibrate sensors, knowing all of the little functions of the anesthesia machines etc. That is imperative to never allow leave one's skillset IMO. Some disregard these nuances but I don't think it's wise. Somehow, those is supervisory roles must never lose the hands on functions of anesthesia. The "monkey skills" so to speak. I agree they are monkey skills but if we find ourselves stool sitting in the future or just doing ASA 3-4's for any myriad of higher risk surgeriess, then they will be important. So, fellow residents, keep this in mind.

Will other "fields" such as CCM and Pain be good options for anesthesiologists? Sure, but there will be plenty of high acuity cases with super sick, comorbid patients needing procedures. Just be very good at what you do. Society will pay for that, albeit not equal to past levels.

 

[bala1]

Medicine is changing. It is what it is. We should fight the battle with less emotion for our own sanity. The alternative is to go crazy fretting about the future.

My own personal ideology is that we can NEVER lose our OR skills. If there comes a day when ACT ratios increase beyond 4:1 I simply wouldn't want any part of that. I'd like to think I'd be prepared to take a major pay cut and stool sit my own cases if it came to that.

To do that, however, requires us to be dialed in to the flow of the OR. Knowing how to calibrate sensors, knowing all of the little functions of the anesthesia machines etc. That is imperative to never allow leave one's skillset IMO. Some disregard these nuances but I don't think it's wise. Somehow, those is supervisory roles must never lose the hands on functions of anesthesia. The "monkey skills" so to speak. I agree they are monkey skills but if we find ourselves stool sitting in the future or just doing ASA 3-4's for any myriad of higher risk surgeriess, then they will be important. So, fellow residents, keep this in mind.

Will other "fields" such as CCM and Pain be good options for anesthesiologists? Sure, but there will be plenty of high acuity cases with super sick, comorbid patients needing procedures. Just be very good at what you do. Society will pay for that, albeit not equal to past levels.

It is very clear to me that you dont have a true understanding of what we do. You are a resident so you have time to learn.

 

[KCBarbarossa]

It is very clear to me that you dont have a true understanding of what we do. You are a resident so you have time to learn.

Why don't you elaborate so that I can learn, but also others (by means of an open forum) can also learn from your wisdom. Seriously, please elaborate.

What is it that you do that I am not understanding?

 

[leaverus]

It is very clear to me that you dont have a true understanding of what we do. You are a resident so you have time to learn.

why? what's wrong with what he wrote?

 

[BLADEMDA]

Medicine is changing. It is what it is. We should fight the battle with less emotion for our own sanity. The alternative is to go crazy fretting about the future.

My own personal ideology is that we can NEVER lose our OR skills. If there comes a day when ACT ratios increase beyond 4:1 I simply wouldn't want any part of that. I'd like to think I'd be prepared to take a major pay cut and stool sit my own cases if it came to that.

To do that, however, requires us to be dialed in to the flow of the OR. Knowing how to calibrate sensors, knowing all of the little functions of the anesthesia machines etc. That is imperative to never allow leave one's skillset IMO. Some disregard these nuances but I don't think it's wise. Somehow, those is supervisory roles must never lose the hands on functions of anesthesia. The "monkey skills" so to speak. I agree they are monkey skills but if we find ourselves stool sitting in the future or just doing ASA 3-4's for any myriad of higher risk surgeriess, then they will be important. So, fellow residents, keep this in mind.

Will other "fields" such as CCM and Pain be good options for anesthesiologists? Sure, but there will be plenty of high acuity cases with super sick, comorbid patients needing procedures. Just be very good at what you do. Society will pay for that, albeit not equal to past levels.

Ratios may indeed increase to 5 to 1 as it already has at some practices. Is this a desirable change? No. But, inevitably the AANA argument of hiring an "equally as safe provider" at $110K to do the easy cases while you supervise 5 rooms (with most of your attention paid to the ASA4 case) will win the day among hospital CEOs.

The days of big, fat subsidies are coming to an end. If the hospital has lots of no pay, Medicaid and Medicare with few commercial insurance patients who do you think will be providing the majority of anesthesia care? (Hint: It won't be you)

Since you are a Resident (as I once was many years ago) I understand your view of the world and financial perspective. That said, that view will change after a few years in practice when you find out what $110K (pretax) will actually buy in the USA.

Even if you decide to earn a low CRNA wage in order to prove a point 99% of your colleagues won't be joining you. The trend is towards more midlevel providers with fewer Anesthesiologists. Patient care is preserved by filtering out the high acuity cases and assigning them to top tier CRNAs or Anesthesiologists to do those cases. Meanwhile, the majority of ASA 1-3 cases are covered with midlevel providers in the most effective manner possible.

The horse is out of the barn here. The CRNA can do the ASA 1 and 2 cases safely and cheaply with minimal supervision. Those are the facts. Patients may prefer a Physician to do the actual anesthetic but who is going to pay for it under ObamaCare? The economic reality is that Medicaid, no pay, Tricare and Medicare do not reimburse sufficiently for a Board Certified Anesthesiologist to personally provide the anesthetic.
MD/DO Groups with no midlevels get away with doing those cases because at least half their other patients have commercial insurance. As ObamaCare phases into full force the number of patients having commercial insurance will decrease while Medicaid/Medicare increases as the primary source of reimbursement.

ObamaCare heavily favors the AANA model of a DNAP CRNA administering the anesthetic while his/her physician supervisor focuses on the most acute cases or assisting with procedures.

If you are entering Anesthesia to do your own anesthetics then a remote area or wealthy area are your best options going forward. The trend is towards the ACT or a hybrid model of CRNA/MD practice as it saves money.

As wages are driven down by economic forces the Anesthesiologist is facing longer hours for less pay but so is the CRNA.

 

[bala1]

Medicine is changing. It is what it is. We should fight the battle with less emotion for our own sanity. The alternative is to go crazy fretting about the future.

My own personal ideology is that we can NEVER lose our OR skills. If there comes a day when ACT ratios increase beyond 4:1 I simply wouldn't want any part of that. I'd like to think I'd be prepared to take a major pay cut and stool sit my own cases if it came to that.

To do that, however, requires us to be dialed in to the flow of the OR. Knowing how to calibrate sensors, knowing all of the little functions of the anesthesia machines etc. That is imperative to never allow leave one's skillset IMO. Some disregard these nuances but I don't think it's wise. Somehow, those is supervisory roles must never lose the hands on functions of anesthesia. The "monkey skills" so to speak. I agree they are monkey skills but if we find ourselves stool sitting in the future or just doing ASA 3-4's for any myriad of higher risk surgeriess, then they will be important. So, fellow residents, keep this in mind.

Will other "fields" such as CCM and Pain be good options for anesthesiologists? Sure, but there will be plenty of high acuity cases with super sick, comorbid patients needing procedures. Just be very good at what you do. Society will pay for that, albeit not equal to past levels.

Why do you think calibrating sensors and knowing all the little functions of the anesthesia machine is a major part of what we do? Are we the patient's doctor or the machine's doctor? And why do you think as an attending even in the supervisory mode would not know how to calibrate a sensor or know the little functions of the anesthesia machine ? And even in the supervisory mode why would you think an attending would to lose the skill set of "stool sitting"?

if i were you I would pay attention to your patient FIRST and FOREMOST and worry about your machine second.

 

[BLADEMDA]

Fact is, graduate CRNA’s continue to grow exponentially more than jobs and as proof I am asked daily when I mention I’m from Florida to anesthesia providers here in Massachusetts; “That’s strange, why are there so many of you “CRNA’s” coming up here from Florida?” Truth be told what this tells me is that the flood of certain markets (Florida being one of them) is starting to spill into other states and with time even those will become saturated as new graduates come out with six figure loans and have no choice but to move as I did in order to pay back aunt Sallie Mae or Uncle Sam.


http://nurseanesthetist.wordpress.com/

 

[KCBarbarossa]

I don't disagree with your priorities. I have the same ones.

So, I'm happy that we agree that we shouldn't ever let those skills go, in spite of 10 +years of supervision which many attendings have. Again, this being all the more important in a less certain future in terms of what "society" is willing to value relative to our profession.

 

[BLADEMDA]

I don't disagree with your priorities. I have the same ones.

So, I'm happy that we agree that we shouldn't ever let those skills go, in spite of 10 +years of supervision which many attendings have. Again, this being all the more important in a less certain future in terms of what "society" is willing to value relative to our profession.

The future is likely to involve hands on anesthesia and supervision. Those "skills" won't be going anywhere anytime soon. You will likely find yourself doing a lot of hands on anesthesia outside the academic world.

Your vision of the "lazy" anesthesia attending sitting in the lounge and never doing a case is NOT the current model of the vast majority of private practices where working hard and hussling means more money/revenue for the practice.

These days with doing blocks, preoping patients, doing lines, etc. supervising cases has NEVER been harder while sitting in the room and actually doing the anesthetic has never been easier.

 

[KCBarbarossa]

Ratios may indeed increase to 5 to 1 as it already has at some practices. Is this a desirable change? No. But, inevitably the AANA argument of hiring an "equally as safe provider" at $110K to do the easy cases while you supervise 5 rooms (with most of your attention paid to the ASA4 case) will win the day among hospital CEOs.

The days of big, fat subsidies are coming to an end. If the hospital has lots of no pay, Medicaid and Medicare with few commercial insurance patients who do you think will be providing the majority of anesthesia care? (Hint: It won't be you)

Since you are a Resident (as I once was many years ago) I understand your view of the world and financial perspective. That said, that view will change after a few years in practice when you find out what $110K (pretax) will actually buy in the USA.

Even if you decide to earn a low CRNA wage in order to prove a point 99% of your colleagues won't be joining you. The trend is towards more midlevel providers with fewer Anesthesiologists. Patient care is preserved by filtering out the high acuity cases and assigning them to top tier CRNAs or Anesthesiologists to do those cases. Meanwhile, the majority of ASA 1-3 cases are covered with midlevel providers in the most effective manner possible.

The horse is out of the barn here. The CRNA can do the ASA 1 and 2 cases safely and cheaply with minimal supervision. Those are the facts. Patients may prefer a Physician to do the actual anesthetic but who is going to pay for it under ObamaCare? The economic reality is that Medicaid, no pay, Tricare and Medicare do not reimburse sufficiently for a Board Certified Anesthesiologist to personally provide the anesthetic.
MD/DO Groups with no midlevels get away with doing those cases because at least half their other patients have commercial insurance. As ObamaCare phases into full force the number of patients having commercial insurance will decrease while Medicaid/Medicare increases as the primary source of reimbursement.

ObamaCare heavily favors the AANA model of a DNAP CRNA administering the anesthetic while his/her physician supervisor focuses on the most acute cases or assisting with procedures.

If you are entering Anesthesia to do your own anesthetics then a remote area or wealthy area are your best options going forward. The trend is towards the ACT or a hybrid model of CRNA/MD practice as it saves money.

As wages are driven down by economic forces the Anesthesiologist is facing longer hours for less pay but so is the CRNA.

Blade, I agree with this synopsis. I'm only suggesting that we may indeed be finding ourselves sitting ASA3-4 cases for high risk surgeries more and more. Hybrid practices exist even now, where CRNA's do the ASA 1/2's for lower risk surgeries and the MD/DO's do the others.

Will that model prevail? Who knows and maybe the model will depend on the type of institution (case acuity and volume etc etc) where one works. Some of us will be supervising 5 or 6 rooms, paying closer attention (as you said) to the higher acuity ones/patients of those 5-6 etc. (not sure how this can be possible really but that's another story), and some of us may be doing our own cases in a mixed MD/CRNA environment, working more or less "solo" and "side by side" the mid-levels.

All I was suggesting is that in order to be able to take this on, we can never let our "monkey business" skills go. They may be more necessary in the future to our daily practice than they are now. That's the only point I was trying to make.

 

[BLADEMDA]

CRNA BLOG

The outlook for the near future is even of greater disparity between job supply and demand as schools continue to pump out more and more students as programs run rampant in offering more slots to potential nurse anesthetists. While creating a large cohort of anesthesia providers to care for the aging America, it worries me that this not only floods the market but enables less prepared students access to what was once known as a prestigious group in the nursing field that favored knowledgeable and respected practitioners. Truth be told, jobs are becoming scarce by the year, and like most other job markets in the U.S. competitiveness for job placement is a reality. Salaries have started to drop the 6 figure mark and for those who plan to live off financial aid, repayment will certainly become challenging especially if job placement is not immediate.


My Two Cents-Blade

(Thanks to the militant AANA/COA market forces have caused CRNA salaries to decrease for the first time ever. The increasing numbers of new CRNAs will drive salaries down across the USA over the next few years. I predict starting CRNA salaries will be around $110K in the next year or two with even some jobs offering $100K or less. )

 

[KCBarbarossa]

The future is likely to involve hands on anesthesia and supervision. Those "skills" won't be going anywhere anytime soon. You will likely find yourself doing a lot of hands on anesthesia outside the academic world.

Your vision of the "lazy" anesthesia attending sitting in the lounge and never doing a case is NOT the current model of the vast majority of private practices where working hard and hussling means more money/revenue for the practice.

These days with doing blocks, preoping patients, doing lines, etc. supervising cases has NEVER been harder while sitting in the room and actually doing the anesthetic has never been easier.

I understand and agree.

 

[BLADEMDA]

CRNA POSTS THE FACTS:


Approximately 4 years ago an extremely large anesthesia group in Florida was offering sign-on bonuses of $10k to $20k per year depending on the location. The same group now is basically overstaffed, overtime is discouraged, benefits have been reduced, sign-on bonuses have disappeared, no raises and they aren’t hiring. The Florida market is flooded with 9 or 10 CRNA schools and 2 AA schools constantly churning out students. Salaries are based on supply and demand, a few years ago there was lack of supply hence the high salaries, sign-on bonuses, benefits, etc. When jobs do get advertised in South Florida the number of applicants is quite substantial. Florida is a state where many people want to live, thus new grads will be taking these lower salaries in order to live here and to pay off student loan obligations. I have heard second hand that the VA in Miami offered someone $91k and they accepted. Tampa General $98k, Cleveland Clinic $100k, and the new norm on Gasworks appears to be $110k. The sooner you get out and find a job the better. Salaries are going to continue to depreciate and benefits reduced for new hires. It’s not going to be as drastic but look at the issue with law school students (oversaturation).

 

[kazuma]

Why do you think calibrating sensors and knowing all the little functions of the anesthesia machine is a major part of what we do? Are we the patient's doctor or the machine's doctor? And why do you think as an attending even in the supervisory mode would not know how to calibrate a sensor or know the little functions of the anesthesia machine ? And even in the supervisory mode why would you think an attending would to lose the skill set of "stool sitting"?

if i were you I would pay attention to your patient FIRST and FOREMOST and worry about your machine second.

It's funny because I ran into this last week. After induction our gas analyzer was malfunctioning. My VA attending tried a couple things like rearranging the layout of the monitor got frustrated, then called a CRNA into the room to trouble shoot the situation. She promptly fixed the problem and I felt embarrassed for the attending.

 

[Consigliere]

It's funny because I ran into this last week. After induction our gas analyzer was malfunctioning. My VA attending tried a couple things like rearranging the layout of the monitor got frustrated, then called a CRNA into the room to trouble shoot the situation. She promptly fixed the problem and I felt embarrassed for the attending.

That attending is a failure and a disgrace to the speciality. The day I have to ask a CRNA to troubleshoot ANYTHING is the day I quit.

 

[IlDestriero]

That attending is a failure and a disgrace to the speciality. The day I have to ask a CRNA to troubleshoot ANYTHING is the day I quit.

Too long with his feet up in the lounge drinking coffee and doing the crossword puzzle.
If you don't understand the machine anymore you should hang it up.

 

[scudrunner]

CRNA POSTS THE FACTS:


Approximately 4 years ago an extremely large anesthesia group in Florida was offering sign-on bonuses of $10k to $20k per year depending on the location. The same group now is basically overstaffed, overtime is discouraged, benefits have been reduced, sign-on bonuses have disappeared, no raises and they aren’t hiring. The Florida market is flooded with 9 or 10 CRNA schools and 2 AA schools constantly churning out students. Salaries are based on supply and demand, a few years ago there was lack of supply hence the high salaries, sign-on bonuses, benefits, etc. When jobs do get advertised in South Florida the number of applicants is quite substantial. Florida is a state where many people want to live, thus new grads will be taking these lower salaries in order to live here and to pay off student loan obligations. I have heard second hand that the VA in Miami offered someone $91k and they accepted. Tampa General $98k, Cleveland Clinic $100k, and the new norm on Gasworks appears to be $110k. The sooner you get out and find a job the better. Salaries are going to continue to depreciate and benefits reduced for new hires. It’s not going to be as drastic but look at the issue with law school students (oversaturation).

That is for nurse anesthetists, not physicians. Although, I'm sure they pay their physicians poorly too. As long as people keep taking those jobs, the pay will continue to stay low.

 

[BLADEMDA]

That is for nurse anesthetists, not physicians. Although, I'm sure they pay their physicians poorly too. As long as people keep taking those jobs, the pay will continue to stay low.

Not too long ago that was the starting salary for Anesthesiologists. Perhaps, those times will be returning once again

 

[bala1]

Too long with his feet up in the lounge drinking coffee and doing the crossword puzzle.
.

I actually know that va attending personally, he gets through the New York times crossword puzzle in less than 20 mins. Im not even kidding. I challenge any CRNA to get through the NYT puzzle in 2 weeks.

 

[bala1]

That attending is a failure and a disgrace to the speciality. The day I have to ask a CRNA to troubleshoot ANYTHING is the day I quit.

Do you ever ask crnas to get you coffee?

 

[Consigliere]

Do you ever ask crnas to get you coffee?

That and to get out of my way. Those are the only 2 things I'll ask a CRNA to do for me.

 

[leaverus]

That and to get out of my way. Those are the only 2 things I'll ask a CRNA to do for me.

i'm no fan of crnas as anyone who's read my posts over the years knows, but i'm a little surprised at your attitude. not that i think you're wrong but that you're able to get away with such open contempt for your "peers," assuming you exhibit that at work? my previous job i was reprimanded several times for treating crna as crnas and not as my equals. and yes, i worked for a doc who was very pro-crna (he was a DO, but i think that just stood for DOuchebag). but even so, i assume in a true ACT model (in which i've never worked) that you are not allowed to treat your crnas as anything but colleagues?

 

[soonerfrog]

There's a clear delineation between colleague, peer, employee, underling, and flat out generalized human indignation. His rage simply manifests itself, childishly, as demeaning condemnation. It shows he's an unpleasant combination of hate and bigotry. Some bad apples just spoil the lot. The contempt pendulum swings heavily on both sides regrettably.

 

[Consigliere]

i'm no fan of crnas as anyone who's read my posts over the years knows, but i'm a little surprised at your attitude. not that i think you're wrong but that you're able to get away with such open contempt for your "peers," assuming you exhibit that at work? my previous job i was reprimanded several times for treating crna as crnas and not as my equals. and yes, i worked for a doc who was very pro-crna (he was a DO, but i think that just stood for DOuchebag). but even so, i assume in a true ACT model (in which i've never worked) that you are not allowed to treat your crnas as anything but colleagues?

I treat CRNAs as my employees, which they are. I respect them as human beings and as mid-level providers but they are certainly NOT my colleagues. I show no open contempt but make no mistake about it....they know who is in charge. I'm not dictatorial, nor do I "micromanage" (CRNAs love that term) the pt's anesthetic, but brother, they know that ANY AND ALL changes in THE PLAN need to be run by me first. We've had a couple of CRNAs throughtout the years that haven't toed the line and they were summarily fired.

 

[Consigliere]

There's a clear delineation between colleague, peer, employee, underling, and flat out generalized human indignation. His rage simply manifests itself, childishly, as demeaning condemnation. It shows he's an unpleasant combination of hate and bigotry. Some bad apples just spoil the lot. The contempt pendulum swings heavily on both sides regrettably.

Thanks, Dr. Phil but you don't know what you're talking about. Cancel your "Psychology Today" subscription and get a clue.

 

[bala1]

I treat CRNAs as my employees, which they are. I respect them as human beings and as mid-level providers but they are certainly NOT my colleagues. I show no open contempt but make no mistake about it....they know who is in charge. I'm not dictatorial, nor do I "micromanage" (CRNAs love that term) the pt's anesthetic, but brother, they know that ANY AND ALL changes in THE PLAN need to be run by me first. We've had a couple of CRNAs throughtout the years that haven't toed the line and they were summarily fired.

You respect them as human beings? Pathetic.

 

[bala1]

have you been on nurse anesthesia . org to get a feel for how some of those jack asses think. They are less than adequate providers. Im not kiddin. They have zero respect for patient safety. Ill repost some of their nonsense on here.It is unfathomable. I know JWK can offer some insight into their minds.

 

[deleted307836]

You respect them as human beings? Pathetic.

This seems over the top - and probably unhealthy for you personally to harbor such contempt for those you may (or may not) work with.

 

[bala1]

my previous job i was reprimanded several times for treating crna as crnas and not as my equals.

Who reprimanded you?

 

[bala1]

This seems over the top - and probably unhealthy for you personally to harbor such contempt for those you may (or may not) work with.

Actually it is quite healthy and i don't have a problem with it. They have contempt for me and other docs , so im giving it back ten fold